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Thursday, January 12, 2006

Waddell's TG clinic celebrates 10 years


To understand the historical significance of the Tom Waddell Health Center's Transgender Clinic, one must travel back in time about 14 years, when many more people believed that gender reassignment therapy was a questionable practice, and yet a dedicated group of professional providers decided to ask the city of San Francisco to begin funding and providing these services to those in need.

Recognizing that the transgender population would seek hormones on its own – and without medical supervision, would often do so unsafely – the staff on Waddell's HIV team began discussing the possibility of providing a medically sound alternative for hormonal therapies, combined with primary medical and psychosocial care targeted toward lower-income people in the Tenderloin, lower Nob Hill, and South of Market districts.

"A couple of us looked around and said there's this whole population that is at risk and that isn't coming to us for medical care, and yet there's something that they want – hormones – that we could be providing if it was safe to do so," recalled Mark Freeman, a nurse practitioner at the clinic. "It was before the term harm reduction had become popular but that was essentially what we were arguing, that with this specialized service they would come to us for what they want, and they would stay for complete healthcare, which would include paying attention to their sexual risk factors, drug risk factors, as well as their athlete's foot or colds or chronic illnesses. The idea was that if people get into primary care and have their own medical provider they are more likely to take their health seriously and believe they can do something about it."

The primary objection to getting such a clinic off the ground, said Freeman, was that "nobody else does this in public health." It took three years of making a case to San Francisco's Department of Public Health for the clinic to get the go-ahead, a move "that was a big step for DPH, and they should be given credit for that," said Freeman. "There were certainly no respectable clinics that provided these services free or low-cost."

It then was up to the staff to conduct research on the effects of hormones despite a lack of long-term studies, and to develop a protocol for how to administer them and monitor the people taking them.

"We were able to assure ourselves that whatever risks were there, they did not seem to be overwhelming," said Freeman. "And if people were able to take those risks, and identified themselves as a transgender person, and they were willing to engage in primary care, then we wanted to be there for them."

Ten years ago, Tom Waddell's transgender clinic became the country's first specialized city-funded clinic of its kind. To celebrate this milestone, an invitation-only party will be held at the Center for Sex and Culture, Tuesday, August 2, from 6 to 10 p.m. Expected guests include Mayor Gavin Newsom, members of the Board of Supervisors and Human Rights Commission, and representatives from area nonprofits and social service agencies. Lipstick Conspiracy, Andy Toon, Veronica Klaus, Nicki Harris, and Ben Keim will provide entertainment. Most of all, the party is to honor the transgender clinic's past and present clients, who have an open invitation to the event.

"The party is really to celebrate our patients," said Mary Monihan, RN. "These people have gone through a lot of difficulties in their lives to live as the person they know they are, and we certainly want to thank them. Everything we learned, we learned through them."

Waddell's transgender clinic operates on an informed consent model with a protocol for administering hormones that includes blood work, a physical exam, and meetings with mental health counselors to assess risk factors and allow the patients "to really explore how transition is going to affect their relationships, their work, the people in their community," said Monihan.

The clinic has about 600 active patients and has seen between 1,500 and 1,800 people throughout its first decade, she said. The majority of the patients are male-to-female, although a growing number of female-to-male clients have been using the clinic in recent years. For the most part, Waddell patients are not represented in high-visibility transgender events such as the Tranny March, said Freeman, but rather, are dealing with daily risks that come with unemployment, homelessness, and other hardships.

"What we're most concerned about are issues like getting the word out for people not to go to 'pumping parties,'" he said, referencing the recent death of a San Diego woman who received illegal silicone injections along with nine other transgender women at a private house party last month.

Pumping parties usually involve out-of-towners without medical licenses who arrange to deliver silicone injections to MTFs who wish to feminize their appearance.

"We have seen so many disasters from these kinds of procedures – silicone in the cheeks that came out through the mouth, buttocks that became infected and then fell into the leg and caused inflammation. These are not implants, it's a direct injection of some substance, which could be kitchen oil or car wax," said Freeman, adding that a Waddell patient lost her life after a pumping party several years ago, and that the clinic sees about one person a month who is dealing with infections, discolorations, inflammations, or migrations from such procedures.

But the Waddell staff members have also witnessed many positive events experienced by their patients. They have, for instance, been privy to the relationships transgender people sometimes form, which have led to the advent of pregnant gay men.

"Two of our patients, both with full beards, were the parents in the delivery room when one of them was giving birth," said Freeman, noting that the clinic had not seen fertility issues in transgender men who stop taking testosterone. "I would have loved to have seen the faces of the nurses in that situation. But good; get used to it."

Additionally, said Freeman, getting transgender people involved in their own healthcare and making them aware of the risks associated with hormones means that more transgender people are becoming healthier.

"I can't tell you how many of our MTF patients have quit smoking because cigarettes affect estrogen levels," said Freeman, who estimates that 80 percent have kicked the habit. "I can't tell you how many FTM patients have lost weight or got their diabetes under control or have done whatever was necessary so that they weren't adding another risk factor with testosterone, but removing a risk factor to do what they needed to do without hurting themselves."

It is also the transgender population at Tom Waddell, said Monihan, that has been the most vocal and articulate whenever the health center has faced budget cuts, and transgenders have repeatedly made the case to city policy makers for funding the center as a whole. When Monihan accepted an award on behalf of the transgender clinic from the transgender community last month, she told audience members that the entire health center owed a great deal to them.

"They have been the most outspoken of all our patients," said Monihan. "We owe the transgender community a lot for keeping our clinic as viable as it is."

For more information about the Tom Waddell transgender clinic, visit If you are a past or present patient of the transgender clinic and wish to attend Tuesday's party, call (415) 307-6290 or (415) 355-7588 to get on the list or to receive an invitation.


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